Finding consensus on the physiotherapy management of asymptomatic infants with cystic fibrosis

Authors

  • S.A. Prasad MCSP,

    Corresponding author
    1. Cystic Fibrosis Unit, Great Ormond Street Hospital for Children, London, UK
    • Cystic Fibrosis Unit, Great Ormond Street Hospital for Children, Great Ormond Street, London WC1N 3JH, UK.
    Search for more papers by this author
  • E. Main PhD,

    1. Institute of Child Health, London, UK
    Current affiliation:
    1. Portex Anaesthesia, Intensive Therapy and Respiratory Medicine Unit, Institute of Child Health, London and Physiotherapy Department, Great Ormond Street Hospital for Children, London, UK.
    Search for more papers by this author
  • M.E. Dodd DSc

    1. Cystic Fibrosis Unit, Wythenshawe Hospital, Manchester, UK
    Current affiliation:
    1. Adult Cystic Fibrosis Unit, Wythenshawe Hospital, Manchester, UK.
    Search for more papers by this author

Abstract

Background

Babies with cystic fibrosis diagnosed by neonatal screening often display no overt signs of respiratory disease. The role of traditional routine daily chest physiotherapy in this particular group of babies is unclear and has generated considerable international debate. There is currently no evidence addressing this issue and present circumstances preclude a rigorous trial in the UK. This study aimed to provide expert consensus regarding the physiotherapy management of asymptomatic infants with CF.

Method

A Delphi consensus method was used to gather and refine expert opinions of senior paediatric physiotherapists in the UK. Agreement was sought on 16 statements reflecting aspects of physiotherapy management in ‘asymptomatic’ babies with cystic fibrosis.

Results

Twenty-five senior paediatric physiotherapists from Specialist CF Centres throughout the UK participated in the study. Consensus was high amongst the respondents for 15 of the 16 statements. One statement failed to reach consensus. This related to the question of not routinely initiating a daily chest physiotherapy regimen in apparently healthy babies. Due to the lack of consensus an amendment to this statement was made, to allow a more flexible approach, where physiotherapists would not be obliged to initiate routine daily treatment in asymptomatic babies with CF, if they felt other another approach was justified.

Conclusion

There was high consensus of opinion amongst senior physiotherapists in the UK on most aspects of the physiotherapy management of babies with CF. Consensus could not be achieved on whether routine daily chest physiotherapy is necessary in ‘asymptomatic’ babies. An agreed amendment to the original statement allows professionals to modify or change traditional practice with the sanction of their senior colleagues. The results of this process will be used by the Association of Chartered Physiotherapists in Cystic Fibrosis to form the basis of national clinical guidelines. Pediatr Pulmonol. 2008; 43:236–244. © 2008 Wiley-Liss, Inc.

Ancillary